6 Questions to Ask When Your Child Complains of Chest Pain

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I see this scenario quite frequently in cardiology clinic. Generally speaking, about a quarter of my new patient visits complain of the following set of symptoms at their appointment:  chest pain lasting for several months, maybe 2-4 times a week, for less than 10-20 seconds at a time, at a moderate intensity, sometimes with activity, but more often not. And the child just recently told his or her parents about it.

Understandably, the parents are worried.

But the good news is that while it’s pretty common for children to say that their chest hurts or even that their “heart hurts,” it’s rarely caused by heart disease.

Most kids will complain of chest pain sometime between age 7 and their teenage years, but thankfully, it will be caused by an underlying heart condition in less than 1% of them. More frequently it is related to a viral illness, stress, or most commonly, musculoskeletal pain.

It is my hope that this information will give parents a little peace of mind: the pain manifesting in your child’s chest is rarely caused by heart disease. But I also understand how concerning it can be for parents, and sometimes further investigation may be necessary to narrow down the cause. So where should parents start?

I suggest answering the following questions:

  1. Has my child been sick recently?
    One of the more common causes of chest pain in children is from costochondritis. This is a condition characterized by inflammation in the joint between the breastbone and the ribs, typically caused by a viral illness or frequent coughing. Costochondritis is not concerning, but in some cases it can be long lasting and your child may need a prescription anti-inflammatory to get rid of it.
  2. Was my child injured recently?
    If your child was hit in the chest during a sporting event or even a fall, this could be a more obvious cause of the chest pain. However, even heavy lifting, frequent coughing, or intense aerobic exercise can strain the rib muscles and cause chest pain. You’ll want to contact your pediatrician if the pain is severe, persistent, or associated with difficulty breathing.
  3. Is my child stressed?
    While it might be difficult to imagine a 7-year-old being stressed, school pressures and the loss of a loved one, for example, can all contribute to feelings of stress. What may be even more surprising is that stress can cause chest pain. While chest pain caused by stress is harmless – it’s really no different than a stress-related headache – the duration of the pain is understandably worrisome for parents.
  4. When does it hurt?
    Does it hurt when your child is sitting down, or only when he or she is active? Chest pain from non-cardiac causes usually happens both when a child is at rest and when they are active. My first question is often whether the pain occurs during gym class or while watching TV. Chest pain that only happens with or immediately following moderate to vigorous activity, such as while running and playing competitive sports, is a different matter which does warrant further medical investigation.
  5. How long has it been hurting?
    Has it been going on for months or even years? If yes, then it is almost certainly not caused by heart disease. Chest pain caused by cardiac disease is either so severe that no child could cover it up or ignore it, or it is progressive and associated with other problems such as passing out or worsening fatigue, that it would be highly unusual for the symptoms to continue over several months. However, non-cardiac chest pain is the very opposite; it can often by ignored, is not associated with other concerns, and often just lingers in the background.
  6. How painful is it? Mild-to-moderate or severe?
    Typically mild-to-moderate chest pain is not related to the heart, and isn’t a cause for concern. However, the more concerning chest pain is when the pain is sudden and severe. Typically it will hurt so bad that your child will not want to go to school and will look like he or she is struggling with the pain. This kind of pain is most often caused by pericarditis, which is an inflammatory condition of the heart. Thankfully, pericarditis is very rare. But what’s interesting about it is that it’s the most common reason that a child’s chest pain is related to the heart. If your child has sudden onset of severe chest pain that is continuous and often occurs around the same time of an illness – contact your child’s pediatrician that same day.

The vast majority of the time, chest pain in children is not related to the heart. While there is no single medical history question or medical test that can determine the source of chest pain, hopefully the six questions discussed above can help parents and teens narrow down what’s potentially worrisome and what’s not. If you have any concerns at all, schedule an appointment with your pediatrician, and have your answers to the above questions ready. They will help steer your pediatrician in the right direction.

Editor’s note: For more frequent heart and health-related thoughts, follow Dr. Madsen on twitter: @MadsenNicolas

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Dr. Nicolas Madsen

About the Author: Dr. Nicolas Madsen

Nicolas Madsen, MD, is a cardiologist at Cincinnati Children’s Heart Institute, with special interest in the prevention of cardiovascular disease. He is focused on research and community outreach programs to find better ways to screen and educate children and adolescents regarding their risks for heart disease or sudden cardiac arrest.

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Comments

  1. Anne August 19, 13:37
    Hi i am 12 years old and sometimes my chest just randomly starts hurting. sometimes it hurts a lot sometimes not, i get it usually like 1 time a month but sometimes its more. Dome anyone know what it could be? Or has someone had the same experience? And should i be worried
    • Minus August 23, 01:35
      I have the same problem, and I am the same age, it usually happens once every two months for me but it has happened twice in this past week. I used to just ignore but they are sharp pains and they effect my breathing. So now you know you aren't alone and I'm experiencing this to.
    • FantasticFox November 08, 18:39
      I'm 11 and have that aswell
    • Joy July 06, 05:08
      I've had the exact same thing I have no idea at all if we should be worried. I honestly hate the pain but I haven't told anyone because my dad is so over protective! When I tell him things about how I'm hurt he's so annoying about it because he wants me to rest when I'm just fine. Btw I'm 11
      • Rachel Camper
        Rachel Camper July 09, 08:52
        Hi Joy, If you haven't already, please talk to your dad about your pain. It may help to watch Dr. Madsen's video together.
  2. Emily September 01, 21:00
    Hi. I'm 13 years old and I play competitive soccer and do track. I tend to have pain in my chest as well after a tiring run/workout/practice. It lasts a while though and when it goes away, it doesn't come back until I run/workout/practice again. Knowing I get this pain, I get worried when I exercise. Should I be worried? How can I prevent this? What could it be?
    • Rachel Camper
      Rachel Camper September 05, 10:18
      Hi Emily, I am sorry to hear that you're experiencing chest pain. I think your first step, if you haven't already, is to discuss it with your parents. You might want to watch Dr. Madsen's video at the top of this post together to determine which symptoms are worrisome and to discuss if a checkup with your doctor is a good idea.
  3. Crisha September 21, 11:44
    Hi i'm 16 years old i been havin chest pain since grade 8 i'm grade 11 now i thought it's gone but not i been having chest pain a lot lately and i didn't tell my parents because they will get mad at me
    • Rachel Camper
      Rachel Camper September 22, 09:44
      Hi Crisha, I think it would be best to inform your parents so that you can determine whether or not your symptoms are worrisome together. It might help to watch Dr. Madsen's video at the top of this post as a first step. If you both are still concerned after watching it, a check-in with your doctor is never a bad idea.
  4. Sissy October 16, 10:38
    My daughter has been complaing since she was 6 that her chest hurts. An she is now 7 an still complaing is it somthang i need to worry about or what
    • Rachel Camper
      Rachel Camper October 17, 11:50
      Hi Sissy, Thanks for taking the time to reach out to us. If you haven't already, I recommend watching Dr. Madsen's video at the top of this post. It does a great job helping to explain the symptoms that may be worrisome. If you're still concerned, a checkup with your daughter's doctor is never a bad idea. Hope this helps!
  5. D’Carlos October 16, 19:12
    Hi there, I’m 15 gonning to be 16 in December which means I’m in GCSE years, yay. I’ve been getting these sudden chest pains and head pains since 14 August 2017 (the day I’m posting s the 16/08/17). They last around a a couple of seconds and then go and sometimes come with no warning. I’ve been to A and E twice (more times in my entire life) and they said everything was fine. The pains started to happen after my undesended testicle surgery, everything thing was fine surgery went as plan. See the thing is I’m a very healthy child 100% attendance every year since reception so for this to happen to me is a suprise. Any help would really help.
    • Rachel Camper
      Rachel Camper October 17, 11:57
      Hi D'Carlos, I'm sorry to hear that you've been in pain. If you haven't already, please discuss what's going on with your parents so that you can work on a game plan together. You may even want to watch Dr. Madsen's video with them, to help determine which symptoms may be worrisome. If you're still concerned, scheduling an appointment with your doctor for peace of mind is never a bad idea.
  6. Lu November 14, 20:07
    My 10 year old grandson has just been diagnosed with pancreatitis. He vomits quite often at home for no apparent reason, but never at my house. He spends each weekend with me and he's fine. He didn't come for 3 weeks and still got sick at home. I'm so confused. Please help. Am I doing something wrong?
    • Rachel Camper
      Rachel Camper November 21, 10:29
      Hi Lu, Is your grandson having chest pain? I think it's probably best to get in touch with your grandson's gastroenterologist to gain his or her perspective on the symptoms he's having. Hope this helps!
  7. SOPH04 November 19, 18:16
    Hi im sophie im 13 and i have been having chest pains for 2 weeks. Sometimes i have shortness of breath and sharp pain in my chest. My body seems colder than usuall but never goes back to how it was (warm/hot) i went in ambulance 2 weeks ago they did ecg and said i was fine then last saturday i went to a &e cos of chest pain they said it probs is your muscle but i dont think it isnt
    • Rachel Camper
      Rachel Camper November 21, 12:03
      Hi SOPH04, I am sorry to hear that you're having chest pain. If you haven't already, please watch Dr. Madsen's video at the top of this post with your parents. It may help you determine which symptoms are worrisome and which aren't. If you're still concerned, it may be best to follow up with the specialist who performed your EKG.
  8. Natalie December 13, 07:52
    Is there anything that an be done to reduce the pain, Advil or Tylenol? This exact thing is happening to my 7 year old.
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author December 13, 12:46
      Natalie – For a child around 7 years old, you could start with some Tylenol. The use of the medication really depends on how long the episodes last and if they are frequent or predictable. If the episodes are brief and random, then by the time you find the Tylenol and give it, the moment will have passed. But if the episodes are longer (maybe 45 min or more), then a little Tylenol might help. Of course, it is also important for me to add that while Tylenol is a safe medication, I would not advise giving it regularly over a long period of time because of the potential for liver injury (meaning for more than 2 weeks as an example). Hope that helps.
  9. fleckolight January 06, 04:12
    My 11 year old son came back from a short holiday complaining that his chest hurt whenever he runs. It's been happening for about a week. He says whenever he runs or jumps or dances - never when sitting or eating or in resting state. He said it feels like a bruise when it happens. He couldn't feel it when he took a deep breathe in but could feel it slightly when I pushed on his chest. Am I right for worrying and going and checking it out with doctor next week?
    • Rachel Camper
      Rachel Camper January 09, 10:42
      Hi fleckolight, It's never a bad idea to have a doctor check something out for peace of mind.
  10. Aiden January 08, 12:46
    Well recently before this weather hit us when baseball was one of my favorites but this one pitcher hit me in the chest and recently it's been hurting- Age 13
    • Rachel Camper
      Rachel Camper January 09, 10:48
      Hi Aiden, If you haven't already, please talk to your parents about your chest pain. You might want to watch Dr. Madsen's video together, and decide if your pain warrants a trip to the doctor.
  11. Jennaa January 19, 10:59
    Hey, I'm 14, chest pains for me have just started today, I woke up at 9am due to chest pains, at has been going on for more than 9 hours, been in bed the whole day due to severe pain, I'm also really lightheaded feel really dizzy and I think I might have a fever, the pain is really bad, tried sitting of sleeping in different positions, nothing works, nothing like that ever happened to me before, this is the first time p and I also have a shortage of breath I don't feel like I can fully catch my breath, please I need help, my mother claims that its due to some cold or whatever but I do not agree. Please help, thank youuu
    • Rachel Camper
      Rachel Camper January 22, 14:28
      Hi Jennaa, If you haven't already, please watch Dr. Madsen's video, which is at the top of this post, with your parents. It may help clarify which symptoms are worrisome and which might not be. If you and your parents are still concerned, a trip to your doctor for peace of mind is never a bad idea. Hope this helps!
  12. Lori January 25, 17:03
    HI, my 16 year old complained of chest pain and difficulty breathing at dance last night. She had told my mom, and i just heard. Her maternal grandmother has long QT syndrome, and ended up in ICU(had a stroke). My daughter is adopted so limited medical info, but she has been tested for longQT, and we were told she does not have it. Wondering if this is something that can happen after you've been tested, or once you've been tested can't happen later on in life?
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author January 29, 14:16
      Lori – It’s a little hard to know how to answer your Long QT syndrome question without knowing what type of testing was done (EKG, exercise test, genetic testing, or other?). The adoption history certainly makes the genetic testing more difficult. The good news is that Long QT syndrome usually is not the cause of chest pain or shortness of breath. More typically, it is associated with passing out if there are any symptoms at all. My advice would be to have a discussion with her pediatrician. If there is a lot of concern, then that can be followed by a visit with a cardiologist. Of course, my assumption is that the Long QT evaluation performed previously was complete, which would make further evaluation by a cardiologist potentially less necessary. The most common reason for the chest pain and shortness of breath in your daughter should be the usual non-heart related type of causes (like pain in the chest muscles themselves). But as I said, given the history, maybe best to start with a simple visit to her pediatrician. Hope that helps!
  13. Nandish February 22, 09:23
    Very useful write-up and helps parents take-away the worries and concerns to a great extent. Though we should not ignore any pain especially in the chest but this type of article helps parents understand what is critical v/s common.
  14. ivanka March 03, 19:19
    Hi, My 11 year old has been touching his left nipple. He said it hurts. He said his right side doesn't hurt. He is saying his left nipple but it could be his left side. My husband thinks it is because he is growing. His body is going through changes. What do you thinks . Mum
    • Rachel Camper
      Rachel Camper March 05, 11:09
      Hi ivanka, I'm sorry to hear that your 11-year old is experiencing chest pain. If you haven't already, please watch Dr. Madsen's video at the top of this post. It may help provide some clarity around whether or not his pain warrants a visit to his doctor for peace of mind.
  15. Ell March 12, 01:59
    Hi im 14years old and my chest all of a dudden keeps getting tight, i have been up all night trying to stay in a position where it wont hurt but the pain keeps coming, it feels like everything behind my brestbone is tightening and i cant breathe as well now either, my mums away so my gran is staying here, what do i do?
    • Rachel Camper
      Rachel Camper March 12, 13:40
      Hi Ell, I'm sorry to hear that you're experiencing chest pain. If you haven't already, I would recommend watching the video at the top of this post with one of your parents. It may help you determine what symptoms warrant a trip to your doctor.
  16. DJ March 26, 08:10
    Hi There, I am 8 years old sometimes I get a sharp pain in my chest for 20 to 30 seconds and it's sore when I breath
    • Rachel Camper
      Rachel Camper March 29, 12:54
      Hi DJ, I am sorry to hear that you're having chest pain. If you haven't already, please inform your parents. You might find it helpful to watch Dr. Madsen's video together to see what symptoms might warrant a visit to your doctor.
  17. Dan April 08, 17:38
    Hi I have cheats pain and when I finishing sport ( dance ), two minutes after. I Felt pain in right side and I am worry.
    • Rachel Camper
      Rachel Camper April 10, 05:39
      Hi Dan, I am sorry to hear that you're experiencing chest pain. If you haven't already, I recommend watching Dr. Madsen's video at the top of this post. It may help you determine which symptoms might warrant a visit to your doctor.
  18. Lulu April 18, 22:00
    Hi, I’m 10 and I get some sharp chest pains too. It usually happens when I’m scared. For example, I went to Dollywood a couple weeks ago and I was scared to go on one of the rides. Then my chest started hurting a bit. I don’t think it’s that big of a deal, but do you have any feedback?
    • Rachel Camper
      Rachel Camper April 19, 11:18
      Hi Lulu, I am sorry to hear that you are experiencing chest pain! If you haven't already, please talk with your parents about your pain. You might even find it helpful to watch Dr. Madsen's video together, to help determine what's worrisome and what symptoms might warrant a visit to your doctor.
  19. Abigail May 13, 15:28
    Hi, I'm 12 and I've been having a sharp/stabbing pain on my left side. Sometimes on my right side, I went to two different doctors one said it was gas the other said it was intercostal muscle strain. I'm very active and run for more than an hour each day. Personally I think It's Costo, but the pain is so severe at points I almost have to stop breathing for 5 minutes, and sometimes I just freeze up in class. It happens every day for the entire day and never goes away. It's been lasting for 2 months help needed please!
    • Rachel Camper
      Rachel Camper May 15, 05:31
      Hi Abigail, I am sorry to hear that you're experiencing chest pain! If you haven't already, please watch Dr. Madsen's video at the top of this post with your parents. It might help you decide which symptoms are worrisome, and which are the more common chest pains that happen in childhood and are not caused by heart disease.
  20. LexiDon June 19, 13:25
    My 6 year old complains of his heart hurting. It's random. He'll just be watching t.v. and playing with his toys and he'll complain his heart hurts. He also, complains while playing more rigorously. It's not everyday just very random and I don't see any pattern. It has been going on for about a month now. He developed a murmur about 2 years ago when he was 4, but it was never looked into. Is this something I should be concerned about?
    • Rachel Camper
      Rachel Camper June 20, 04:59
      Hi LexiDon, I'm sorry to hear that your six year old is in pain! If you haven't already, please watch Dr. Madsen's video at the top of this post. It may help you determine which symptoms are worrisome and which aren't. If you still have concerns, a checkup with his doctor is never a bad idea for peace of mind!
  21. Lyanna June 21, 23:41
    Hi, I'm a girl and when i was 12 years old I felt something strange in my chest because when I bend my back so that my chest sticks out, I get this feeling that a tape is being remove on the skin from the lower left side of my sternum (hope you get it) and when I told my mom about this she told me that it was nothing so I just ignored it. And now that I'm 16 years old I felt a hard L-shape lump on the left side of my sternum and sometimes I feels a stabbing sensation in that area. I've been very anxious ever since and I search it in the internet and it makes me feel more anxious because of the things showing up. Hope you reply, thank you.
    • Rachel Camper
      Rachel Camper June 25, 13:07
      Hi Lyanna, I am sorry to hear that you're experiencing pain. I would encourage you to speak to your parents about it again. And if you're still concerned, schedule a visit with your doctor to look into it further.